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CNS > Lecture 13 - Dementia And Delirium > Flashcards

Lecture 13 - Dementia And Delirium Flashcards

1
Q

What is dementia?

A

A chronic progresssive syndrome of insidious onset where theres progressive destruction of neurons

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2
Q

What are the 4 types of dementia?

A

Alzheimer disease
Vascular dementia
Lewy-body dementia
Frontotemporal dementia

Aids related dementia

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3
Q

What is thought to be the main 2 causes of Alzheimer dementia?

A

Formation of:

-Plaques
-Tangles

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4
Q

What forms the plaques in Alzheimer dementia?

A

Beta amyloid plaques

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5
Q

What forms the tangles that’s thought to cause Alzheimer Dementia?

A

Tau proteins

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6
Q

What is the pathophysiology of plaque formation in Alzheimer disease?

A

Amyloid precursor protein broken down by beta secretase leading tot formation of INSOLUBLE B amyloid plaques which aggregate

Normally amyloid precursor protein broken down by. Alpha and gamma secretase into soluble wastes

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7
Q

What is the downside to beta amyloid plaques forming in Alzheimer dementia?

A

Thought to induce inflammation
Neuronal death

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8
Q

What is thought to be the pathological process behind the formation of tangles in Alzheimer dementia?

A

Tau protein tangles form due to hyper phosphorylation of Tau

Likeli caused by Beta amyloid plaques

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9
Q

What is the normal function of Tau proteins?

A

They stabilise microtubules in the neuronal cytoskeleton

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10
Q

What are the macroscopic changes to the brain that occur during Alzheimer disease?

Which area is typically affected first?

A

General brain atrophy (Hippocampus is often affected first)

Narrowing of gyri
Widening of sulci
Ventricular enlargement

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11
Q

What neurotransmitter levels decline in Alzheimer disease and why?

A

Acetylcholine (ACh)

Since new memory making is impaired and ACh needed for processing memory and learning

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12
Q

What are the general class of drug used to try and treat Alzheimer disease and why?

A

Cholinesterase inhibitors (donepezil)

Help increase level of already declined ACh

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13
Q

What are the 3 types of Alzheimer dementia?

A

Sporadic
Familial
Trisomy 21 (Down syndrome linked)

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14
Q

What is the most common cause of Alzheimer disease?

A

Sporadic

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15
Q

What is thought to be the casuative gene in familial Alzheimer disease?

A

PSEN 1/2

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16
Q

What are the symptoms of Alzheimer disease?

A

Slow developing

Short term memory loss (hippocampus)
Motor and language then affected
Long term memory loss
Disorientation
Immobilisation

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17
Q

What is thought to be the main cause of death related to Alzheimer disease?

A

Death usually related to the fact that the patient is immobile

(E.g more likely to get chest infections like pneumonia and die)

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18
Q

How is Alzheimer dementia diagnosed?

A

Diagnosis of EXCLUSION

Need to be sure no other disease process can cause symptoms:
-hypothyroidism
-Hypercalcaemia
-B12 deficieny
-Delirum

CT scan

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19
Q

What treatment is given for advanced Alzheimer dementia and why?

A

Memantine

Is a glutamate receptor antagonist
Levels of glutamate increase as neurones die so memantine protects the nerve cells from the high levels of glutamate

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20
Q

What are some general cognitive symptoms of dementia?

What lobe would be involved with each symptom?

A

Impaired memory (Temporal lobe)
Impaired orientation (temporal lobe)
Impaired learning (temporal lobe)
Impaired judgement (frontal lobe)

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21
Q

If a patient has behavioural symptoms associated with their dementia, which lobe has likely been affected?

A

Frontal lobe

Sexual disinhibition
Aggression

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22
Q

What is the difference between visual and auditory hallucinations and persecutors delusions?

A

V and A hallucinations are false perceptions
Whereas
Persecutors delusions are false beliefs

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23
Q

What type of neurones are mainly affected in Alzheimer dementia?

A

CHOLINERGIC
Noradrenergic
Serotonergic

24
Q

What is Lewy Body Dementia?

A

Dementia which then goes on to develop. Parkinsonian like symptoms

25
Q

How does the speed of developmetn of Lewy Body dementia compare to the speed of onset of Alzheimer dementia?

A

Lewy body dementia = more rapid onset

26
Q

What is thee cause of Lewy body dementia?

A

Misfolding of Alpha synuclein proteins

27
Q

Where are alpha synuclein misfolded protiens deposited to cause the dementia type symtpoms?

A

Cortex

28
Q

Where are alpha synuclein misfolded proteins deposited to cause parkinsonian like features?

A

Substantia nigra

29
Q

What do the misfolded synuclein proteins aggreate to form?

A

Lewy bodies

30
Q

What are the early cognitive symtpoms of Lewy body dementia?

A

Distressing hallucinations (small people and furry animals)
Depression
REM sleep disorders (sleepwalking and talking)

31
Q

What are some later parkinsonian symtpoms of Lewy body dementia?

A

Bradkinesia
Resting tremor
Stiffness

32
Q

What is the treatment for Lewy body dementia?

A

Based on symptoms
Levodopa (dopamine analogue)

33
Q

Why do you not give dopamine antagonists (antipsychotics) for Lewy body dementia?

A

Can cause neuroleptic malignant syndrome which is a psychiatric emergency

34
Q

What are the signs/symptoms of neuroleptic malignant syndrome?

A

Fever
Encephalopathy
Elevated creatine phosphokinasse
Rigidity

35
Q

What is fronto-temporal lobe dementia?

A

Frontal and temporal lobe atrophy

36
Q

What are the signs and symtpoms of fro to-temporal lobe dementia?

A

Behavioural disinhibition
Innappropriate social behaviour
Loss of motvaiotn without depression
Non fluent Broca’s aphasia

This are all mainly due to frontal lobe atrophy

37
Q

What is thought to be the pathophysiology of fro to-temporal lobe dementia?

A

Aggregated proteins and Tau protein hyper-phosphoryaltion

38
Q

What happens as a result to damage to the frontal lobe and then temporal lobe in front-temporal dementia?

A

Frontal:
-behavioural and emotional changes
-disinhibition

Temporal:
-language impairment

39
Q

What is seen on MRI with fro to-temporal dementia?

A

Frontal/temporal atrophy
Ventricualr enlagremnt

40
Q

What is vascular dementia?

A

Where cognitive impairment is caused by cerbrovascular disease (multiple mini strokes)

41
Q

What are the risk factors for vascular dementia?

A

Any risk factors increasing risk of CVD:
Previous stroke MI
Hypertension
AFIB
Hypercholesterolaemia
Diabtes
Smoking

42
Q

How does vascular dementia present?

A

Depends on area of brain affected

43
Q

How does Vascualr dementia present on CT head?

A

Paler areas of infarcted cerebal tissue

44
Q

How is vascular dementia treated?

A

Treat the risk factors (AIFB hypertension)

45
Q

What is the pathology of AIDS/HIV dementia?

A

HIV infected macrophages cross the blood brain I barrier leading to damage oof neurones

Its the viral proteins damaging the brain not any opportunistic infections

46
Q

What symptoms can AIDs dementia cause?

A

Behaviour
Memory
Thinking (psychomotor retardation)
Movement (cerebellar involvement)
Ataxia
Dysarthria
Incontinence

47
Q

Why is HIV/AIDs dementia increasing?

A

People with HIV and AIDs are living longer so more cases are being seen

48
Q

How is AIDs dementia managed?

A

Bio-psycho-social model

Bio:
Acetylcholinesterase inhbitors (donepezil)
NMDA antagonists (memantine)

Social
Explain diagnosis sensitively
Driving

49
Q

What is delirium?

A

An acute confusional state which is an acute fluctuating syndrome of disturbed consciousness attention and perception

50
Q

What are the features of deliurm?

A

Rapid onset confusion
Clouded consciousness
Fluctuating course
Transient visual hallucinations
Often exaggeretaed emotional responses

51
Q

What are the 2 types of delirium?

A

Hypoactive
Hyperactive

52
Q

What are some features of hypoactive delirum?

A

Withdrawn
Quiet
Sleepy

53
Q

What are some features of hyperactive delirium?

A

Restless
Agitated
Aggressive

54
Q

What arer some causes of delirium?

A

Drugs
Epilepsy /electolyte imbalance
Liver failure /low oxygen
Infection
Retention(urine/faecal)
Intracranial
Uraemia
Metbolism

55
Q

What is the treatment of delirium?

A

Minimise/treat precipitating factors
Encourage normal day and night cycle
Allow wandering if safe

Medication is last resort (Haloperidol)

56
Q

Go to slide 29 and label delirium vs dementia

A

CNS (21 decks)

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